Ever wonder why semaglutide is making waves in weight management?
Ozempic/Wegovy has been making headlines lately, popping up in the news for various reasons. Celebrities are taking it, shortages are impacting those with diabetes, and there are even talks about how it might affect the real estate market. But what is Ozempic/Wegovy, and why is it such a big deal in the media?
What is it?
Ozempic/Wegovy is the brand name for a drug called semaglutide. It's not your typical pill – it's an injection that you can get only if a doctor prescribes it. Back in 2017, it was first approved in the U.S. to help with type-2 diabetes. Now, Ozempic is the brand name used to treat diabetes, and Wegovy is the one for obesity, but both use the same semaglutide. It wasn't until recently, in 2021, that this drug got the green light to be used specifically for obesity, under the name Wegovy.
How does it work?
Semaglutide acts like something your body naturally produces, called glucagon-like peptide 1 (GLP-1).1 This drug connects with the GLP-1 receptors in your body, making you feel less hungry and fuller. It also helps lower blood sugar levels. For people with type-2 diabetes, it helps manage their blood sugar, and for those looking to shed some pounds, it aids in weight loss. However, like any medication, there can be side effects, including nausea, diarrhea, vomiting, constipation, headaches, low blood sugar, and more.
What does the research say?
Scientists conducted a big study called the STEP (Semaglutide Treatment Effect in People with obesity) clinical trials to see if semaglutide could really help people lose weight and keep it off. In STEP 1, those taking semaglutide lost around 14.9% of their weight, way more than the 2.4% lost by those on a placebo during the 68-week trial. In STEP 3, people got therapy to help with weight loss, and those on semaglutide lost 16.0% of their weight, while those on the placebo lost 5.7%. For STEP 4, everyone in the trial started semaglutide for the first 20 weeks, then some people continued with semaglutide for 48 more weeks and lost more weight, while others switched to a placebo and gained weight. The results showed that continuing with semaglutide helped lose an extra 7.9%, while those who switched to a placebo gained 6.9%. It is this last trial that has generated a lot of interest in doctors because of metabolic adaptation.
Metabolic Adaptation to Weight Loss
Metabolic adaptation refers to the body's ability to adjust its metabolic rate in response to changes in energy intake, particularly during weight loss.2 As individuals reduce their calorie intake to lose weight, the body undergoes various changes to preserve energy and maintain itself. These physical changes can determine how much weight a patient loses and whether they will gain it back later. There are four main components to metabolic adaptation.
- Basal Metabolic Rate (BMR) Adjustment: When a person reduces their calorie intake to create a calorie deficit, the body may respond by lowering its basal metabolic rate (BMR). BMR is
- Changes in Hormonal Regulation: Hormones play a crucial role in regulating metabolism. During weight loss, hormonal changes occur to tell the body to conserve more energy. Leptin, a hormone produced by fat cells that regulates appetite and energy expenditure, decreases during weight loss. This reduction in leptin levels can stimulate hunger and slow down metabolism, which can lead to regaining weight.
- Muscle Mass Loss: Consuming less calories, especially in the absence of resistance training, can lead to the loss of lean body mass, including muscle tissue. Muscle tissue burns more calories when put to use, so when you lose muscle mass it becomes more difficult to burn calories and lose weight. Preserving muscle mass through resistance training is important to avoid this issue.
- Energy Efficiency Improvement: The body becomes more efficient in using energy as individuals lose weight. This increased efficiency means that the body can perform the same activities with fewer calories. While efficiency is beneficial for survival in times of food scarcity, it can hinder weight loss efforts and can make you regain weight.
Semaglutide does not directly affect metabolic adaptation to weight loss, but it may indirectly influence metabolic processes by changing appetite, blood sugar, and body composition. This possibility of weight loss that can be maintained is what has made semaglutide such a hot topic with some doctors and the media. No matter what weight loss method you choose, it is important to consult a doctor before starting any kind of weight loss program. They are the most qualified people to discuss the risks, benefits, and any possible negative outcomes of a specific program or method.
Hormones – These are chemicals produced in our body that act as messengers, traveling through the bloodstream, to regulate growth, metabolism, mood, reproduction, and many other functions.
Metabolic Rate – This is the rate at which your body uses energy to do basic things such as breathing, regulating your body temperature, and circulating blood.
Placebo – This is a substance or treatment with no effect that is used in research to compare how well a drug or other treatment works. This helps determine if people in a study feel better just because they believe they are taking medicine, even if it’s not real.
Type 2 Diabetes – This is an acquired condition where a person’s body has become resistant to insulin which makes it more difficult for their body to regulate their blood sugar effectively. If not managed, the high blood sugar levels from this condition can lead to more serious health problems such as heart disease, stroke, or even death.
- Bergmann NC, Davies MJ, Lingvay I, Knop FK. Semaglutide for the treatment of overweight and obesity: A review. Diabetes Obesity Metabolism. 2023;25(1):18-35. doi:10.1111/dom.14863
- Martínez-Gómez MG, Roberts BM. Metabolic Adaptations to Weight Loss: A Brief Review. J Strength Cond Res. 2022;36(10):2970-2981. doi:10.1519/JSC.0000000000003991